Non-Hospitalized Heart Failure in the Community: Characteristics of Self-Reported and Outpatient Heart Failure

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Last Modified
  • March 19, 2019
Creator
  • Camplain, Ricky
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Heart failure (HF) is a clinical syndrome defined by combinations of signs and symptoms. It is associated with impaired quality of life, severe disability, and risk of death. Due to its high prevalence and the frequency of associated hospitalizations, HF is the leading hospital discharge diagnosis among Medicare patients. This doctoral research addressed the agreement of self-reported HF with confirmation of HF by the interviewee’s health care provider, hospital medical record extraction, and the presence of HF diagnosis codes in administrative claims. Trends in period prevalence and incidence rates of HF seen in emergency departments and ambulatory care clinics from 2007 to 2014 were also estimated in a national probability sample of Medicare beneficiaries. Compared to objectively measured HF among ARIC study participants, sensitivity of self-report was low (28-38%), specificity was high (96-97%), and agreement was poor (kappa 0.32-0.39). The prevalence of HF was similar whether measured by either self-report (9.0%), classification of HF hospitalizations (11.2%), or administrative claims for HF (12.7%). Among CMS Medicare fee-for-service beneficiaries, the period prevalence and incidence of HF in emergency departments were higher among black and older beneficiaries. The period prevalence of HF in emergency departments was stable from 2007 to 2014. During the same period, the incidence of HF in emergency departments increased among all Medicare fee-for-service beneficiaries. The period prevalence and incidence of HF seen in ambulatory clinics were higher among men, black, and older beneficiaries. The period prevalence decreased from 2007 to 2014. The incidence of HF seen in ambulatory clinics decreased from 2008 to 2012, increased from 2012 to 2013, and finally decreased slightly in 2014 among all subgroups. We conclude that accurate estimates of the burden of HF in populations require that patient-centered self-reports of HF be confirmed against sources such as diagnostic tests or medical records. Further, the incidence of HF seen in emergency departments and ambulatory clinics increased from 2008 to 2014 among Medicare beneficiaries. Trends are temporally aligned with the decline of HF hospitalizations in the United States. These diverging temporal trends in HF may reflect the effect of policies designed to reduce hospitalizations for HF.
Date of publication
Keyword
DOI
Resource type
Rights statement
  • In Copyright
Advisor
  • Heiss, Gerardo
  • Loehr, Laura
  • Layton, J. Bradley
  • Keyserling, Thomas
  • Kucharska-Newton, Anna
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
Language

Relations

Parents:

This work has no parents.

Items

Thumbnail Title Date Uploaded Visibility Actions
file details Camplain_unc_0153D_16949.pdf 2019-04-12 Public Download
file details PREMIS_Events_Metadata_0_ee152a84-e34c-4e1c-953a-e35f7182764f.txt 2019-04-12 Public Download
file details original_metadata_file_ee152a84-e34c-4e1c-953a-e35f7182764f.xml 2019-04-12 Public Download